RUTH WALKER: If women are getting their intake of key nutrients from supplements, does a healthy diet really even matter? Can women get more benefits from having supplements than they can from whole foods? What we know about women’s intakes during pregnancy is that generally most of them don’t meet their nutrient requirements through foods alone. However, the importance of whole foods is still very important. What I’m going to talk about now is the concept of food synergy. And that is the idea that foods, when eaten as part of a whole-food diet, work together to optimize the nutrient benefits for women. I’ll give you a small example first. So what we have here is an orange.
We also have iron-containing foods such as lean red meat, tofu, tempeh, and legumes. What we know is that, when you consume an orange that has vitamin C in it with iron-containing foods, that actually assists with absorption. So therefore women are getting the benefits of many nutrients. A more complicated example of that is the Mediterranean diet. So the Mediterranean diet consists of a variety of green, leafy vegetables, legumes, nuts, seafood, mono-unsaturated oils, and whole grains. So with the Mediterranean diet, we know that that’s associated with lower risks of chronic conditions such as cardiovascular disease.
What we don’t know is what aspect of the Mediterranean diet leads to optimal health outcomes later on in life or at least the prevention of chronic diseases such as cardiovascular disease. But what the Mediterranean diet is, it’s an example of how the components of food– the nutrient and non-nutrient components– work together synergistically to promote optimal health outcomes. So supplementation might be beneficial for women who are experiencing nutritional deficiencies. And these are women who perhaps are vegetarian, adolescents, they’re on special diets already, or they might have some sort of addiction such as drugs or alcohol.
We also know that supplementation is beneficial for the prevention of some conditions such as neural tube defects and, in the case of iodine, cognitive development in children. International agencies plus governing health bodies of countries such as Australia, the US, and the UK recommend that women should meet their nutritional needs for pregnancy primarily through the consumption of whole foods. So that consists of foods from the five food groups– grains and cereals, vegetables, fruits, dairy, meat, and alternatives. So the food matrix is the nutrient and non-nutrient components of food. A good way to explain the food matrix is to take an example of an orange. This orange contains fibre, carbohydrates, vitamin C, and phytochemicals.
When we consume it in its original form, we get the benefit of all of these nutrients. However, when we change the matrix of the food we change the nutrients that are in the food and how they’re absorbed into our body. And this has a subsequent effect on how it effects our satiety. So let’s take a look at the juice from one orange. This juice contains phytochemicals, vitamin C, and carbohydrates. However, it’s lost all its fibre content. Also, the juice from this one orange looks a little bit disappointing whereas, if you were to have this whole orange, it might make a reasonable snack or at least an addition to a meal.
Most people are more likely to either have a whole glass of orange juice or a bottle from the shop. So that makes it very easy for people to consume more than what they need. And in the case of pregnancy, if women consume too much energy they’re more likely to experience excessive gestational weight gain. This orange contains 200 kilojoules or 48 calories. This glass of orange juice contains 365 kilojoules or 90 calories while this bottle of orange juice contains almost 900 kilojoules or 200 calories.
So it’s really important when we consider food we consider its original food matrix, consider how we can change it as little as possible in order to get the benefits from all the nutrients that are within that food matrix. If we look a little bit more deeply into this example, we can take an orange. And we can take a vitamin C supplement. So this orange contains 45 milligrams of vitamin C. And this is enough to meet the needs of adults. During pregnancy, our intake or our requirements are a little bit higher. But still, it meets about 2/3 of the requirements during pregnancy.
This supplement, on the other hand, contains 200 milligrams of vitamin C, well in excess of what adults need and what women need during pregnancy. Now, that’s not a problem. It’s not harmful because any excess vitamin C is excreted as urine. However, if we take this orange we’re getting the benefits of fibre, carbohydrates, and phytochemicals as well as vitamin C whereas, if we just take this little vitamin C supplement, all we’re getting is vitamin C and probably a little bit more than what we need and a little bit more than what’s going to be useful to our bodies anyway. Dietitians are expert in the area of foods and supplementation and optimizing nutritional status.
And, therefore, they might be very useful allies when you’re working with women who are pregnant, particularly those who are experiencing deficiency or who are at risk of deficiency. So these are some practice points to take away. Promote a food-first approach to pregnant women. Inform pregnant women that the nutrient and non-nutrient components of food work together to improve health. Only consider supplementation when you nutrient needs aren’t able to be met through dietary intake alone. Consider a team approach involving collaboration with a dietitian to optimize women’s nutritional status during pregnancy.